Provider Demographics
NPI:1245534254
Name:LEVINE, ROBERT E. MD, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:LEVINE, ROBERT E. MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-860-0800
Mailing Address - Street 1:9001 WILSHIRE BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1841
Mailing Address - Country:US
Mailing Address - Phone:310-860-0800
Mailing Address - Fax:310-773-9208
Practice Address - Street 1:9001 WILSHIRE BLVD STE 306
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1841
Practice Address - Country:US
Practice Address - Phone:310-860-0800
Practice Address - Fax:310-773-9208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG14579207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG14579OtherMEDICARE ID- TYPE UNSPECIFIED
CAG14579OtherMEDICARE ID- TYPE UNSPECIFIED
CAG14579OtherMEDICARE ID- TYPE UNSPECIFIED